Infertility Flashcards
What is secondary infertility?
conceived at least once and not again for at least one year
what is primary infertility?
never conceived
What is FMS?
follicular maturation study
What is one part of hx that is important in infertility?
how long the couple has been trying to conceive
What are the prime causes of infertility?
most common = unexplained
sperm problem
ovulatory failure
tubal damage
endometriosis/cervical mucous
coital problems
other
what are the steps of conception?
ovulation
insemination
fertilization
transportation
implantation
What do you evaluate with infertility as it pertains to the cervix?
provide non-hostile environment to harbor sperm
glands that secrete mucus and crypts that hold sperm
ultrasound: used to evaluate cervical length during pregnancy to assess for cervical incompetence
What are you evaluating considering infertility in relation to the uterus?
assess structural anatomy
assess endometrium
assessing for structural anatomy refers to evaluating uterine shape DES exposure
echogenicity
masses - fibroids
What would you asses in the endometrium in relation to infertility?
echogenicity
masses - fibroids
assess endometrium
When would you measure the endometrium for appropriate change?
throughout the menstrual cycle
what happens in the first part of the menstrual cycle as it pertains to infertility?
mucosa begins to proliferate because of increasing estrogen levels
after ovulation progesterone is secreted by _________
corpus luteum
secretion of progesterone begins what
the secretory phase of the endometrial cycle
during the secretory phase, endometrium becomes ___________ and very __________ as result of ________ ________
thickened
very echogenic as a result of stromal edema
loos of triple line sign
how big does the endometrium need to be in order to achieve pregnancy?
at least 6 mm
if there is not enough progesterone produced in the luteal phase what kind of endometrial lining will you see by US?
thin lining
what is the lack of progesterone production known as what?
luteal phase deficiency
may be associated with infertility and early pregnancy loss
why is endometrial appearance important?
for planning for infertility treatment with embryo transfer
What can cause irregular endometrium?
submucosal fibroids
polyps
adhesions
synechiae (scarring)
what procedure do you do in order to see abnormal structures in the endometrium?
SIS (saline infusion sonography) aka sonohysterogram
further delineates anatomic structure of the endometrium
With infertility, what are you looking for when evaluating the Fallopian tubes?
hydrosalpinx
tubal patency
What do you assess in the endometrium?
evaluate thickness
echogenicity characteristics
evaluate intracavitary lesions
What causes a 50% reduction in pregnancy rate and doubling of spontaneous miscarriage rate?
hydrosalpinx
Removing what structure improves in vitro fertilization success?
Fallopian tubes
How do you determine tubal patency?
assessed by injecting saline into tube and looking for spillage of fluid into cul-de-sac or by using contrast to evaluate for spillage.
where do sonographers look for spillage of saline or air?
around the ovary
into the posterior cul-de-sac
During the procedure to check for spillage, if none is noted and the patient complains of pain during injection, what might be the problem?
blocked Fallopian tube
What can obstruct the Fallopian tube?
adhesions
What is the normal ovary/follicle?
during follicular phase:
several antral follicles on ovary < 5mm
dominant follicle grow 1-3mm/day until reaches about 22mm
22mm follicle ruptures (will either increase or decrease in size)
Sonographic findings:
echoes within fluid left behind (corpus luteum cyst)
free fluid in peritoneal cavity
What are the key drugs used in ovarian induction therapy?
clomiphene citrate (clomid) oral
human menopausal gonadotropins (pergonal) injected
Once ovarian induction therapy is started when is ultrasound used to monitor number and size of follicles?
days 8 to 14 (follicular phase) of menstrual cycle
count and measure all follicles > 1cm in sag and trv planes
With ovarian induction therapy, what is the optimal mean measurement of the mature follicles?
between 16 and 20 mm
What is correct measurement of folllicles important?
because hCG (substitute for LH) may need to be given intramuscularly to trigger ovulation (Pergonal)
With ovarian induction therapy, What should the endometrium be doing?
Assess thickness and echogenicity pattern of endo cavity
normal endo response assoc with ovarian stimulation is 2-3mm to 12-14mm
sonographically:
measure endo thickness - trv uterus transvag in sag plane
measure from anterior to posterior endometrial interface
What is OHSS (ovarian hyperstimulation)?
syndrome that presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites and pleural effusions
If a patient has OHSS what actions are taken?
patient will be removed from medication immediately and may be off for several months
What is assisted reproductive technology - ART?
in vitro fertilization (IVF) is the method of fertilizing the human oocyte outside the body
treatment plan: ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization and transferring embryos into uterus
How is oocyte retrieval accomplished with what?
transvaginal ultrasound guidance
how many follicles are evaluated for IVF, 2 or 4?
4
How do the doctors get control of the cycle?
by using Lupron or Synarel - stops ovarian function
what are the complications of ART?
OHSS
Ectopic - heterotrophic pregnancies higher risk with ART patients
multiple gestations
What is anovulation?
failure of hypothalamus and pituitary to produce hormones to stimulate ovuation
FINISH slide 42
Does regular menses guarantee the ovulation of an oocyte?
no
What is luteal phase inadequacy?
inadequate output of progesterone in second half of cycle
creating thin endometrium
what shape of uterus has the highest rate of infertility?
septate
What are the most common factors that may cause infertility?
low sperm count
anatomic defects
disease
Fallopian tube scarring
